Premenstrual Syndrome (PMS)
By The Jean Hailes Foundation for Women`s Health
What is Premenstrual Syndrome?
PMS occurs when a woman experiences recurrent symptoms in the seven to ten days before the period begins. Symptoms cease before or during the period, followed by a symptom-free week. Some women, however, experience symptoms from ovulation which may last until the next period commences.
PMS is more common in women over the age of 30, but may occur in younger women.
Not all women suffer PMS. Some suffer mild to moderate symptoms for a day or two only, whereas a small number of women (about 5%) suffer severe symptoms which interfere with their quality of life at some stage during their reproductive years.
What causes PMS?
The exact cause of PMS is not known but it is believed to be a complex condition involving emotional, physical, hormonal and environmental factors. PMS occurs in the presence of a regular menstrual cycle with normal levels of hormones. It is not a state of hormonal imbalance.
The following factors may influence premenstrual symptoms:
- Stress levels and a woman’s current psychological state
- Cultural and social environment
- Changes in neurotransmitters (brain chemicals), particularly serotonin, which are lower in the premenstrual phase before the period in women with PMS.
What are the most common symptoms?
Whilst many women do not suffer PMS, others may suffer one or more of the following symptoms:
Emotional Symptoms:
- irritability
- anxiety
- nervous tension
- mood swings
- lower coping ability
- depression
- aggression
- difficulty concentrating
- lower libido, rarely increased libido
- feeling unloved
- wanting to be alone
- reduced interest in work and social life
Physical Symptoms
- fluid retention (swollen fingers or ankles)
- bloating around the abdomen
- breast swelling and tenderness
- headaches ranging from mild to a severe migraine
- tiredness, lethargy, insomnia
- increase in weight
- constipation
- food cravings, especially sweet foods
- aches and pains, particularly lower back, legs and abdomen
- poor coordination or clumsiness
- skin problems such as acne
- occasionally increased energy
How do you tell if your symptoms are PMS?
Whether you suffer one or a few of the above symptoms, it is the timing of the symptoms that will indicate whether or not you are suffering PMS. Symptoms due to PMS will only occur after ovulation (mid-cycle) and will disappear during the next menstrual period. Mark your symptoms on a calendar or keep a daily menstrual chart over two to three months to help your doctor with the diagnosis.
Lifestyle factors that may help towards relieving your PMS symptoms
- Eat regular, healthy meals including plenty of vegetables, fruit, mixed grains and cereals
- Eat small meals to maintain stable energy levels, this will also significantly reduce food cravings
- Drink less caffeine – particularly if you are suffering breast tenderness. Try drinking water instead! (6-8 glasses a day)
- Cut down on alcoholic beverages
- Cut down on salt and salty foods to help reduce fluid retention
- Get enough rest, sleep and exercise
- Don’t smoke
- Wear a well fitting cotton bra if you suffer tense, painful breasts.
Exercise
Regular exercise is important, particularly during the premenstrual phase. Walking is an excellent form of exercise and has the advantage of being both cheap and easy for most people. Swimming, yoga, aerobics, netball, tennis, golf and cycling are other suggestions. Make sure you choose a form or variety of exercise you enjoy – otherwise you will not pursue it.
Exercise increases endorphins (one of the brain’s neurotransmitters, or chemicals, which decrease premenstrually in PMS sufferers) and therefore may reduce symptoms. Endorphins also act as natural pain killers and help you to feel more relaxed and in control.
Reduce Stress
- Make an effort to avoid extra stresses (mark your premenstrual time on the calendar so that you can avoid major activities)
- Talk to your family about your PMS so they can have some understanding of the problem. Help them develop strategies to be supportive during this time
- Try not to take your aggression out on your family
- Take time out to relax and enjoy your own interests
- Try to develop your ‘positive’ thinking
- Seek professional counselling
If your PMS symptoms continue to distress you, consult your doctor. It is important that other possible causes of the symptoms are excluded. Although no 'cure' can be offered there are many treatments that help reduce and, for some women, completely alleviate PMS symptoms. It may be necessary to try different treatments before you find the most effective one for you.
Treatment of PMS
Natural Therapies
Many women feel they benefit from a variety of natural therapies but none have been proven in controlled studies to be beneficial, their effects being no better than placebo, i.e. about 30-40%reduction in symptoms.
Vitamin B6 (Pyridoxine) has been used to reduce emotional symptoms and fluid retention but in doses no greater than 50-100mg per day, as high doses can lead to peripheral neuropathy or loss of sensation in fingers and toes.
Evening Primrose oil has been used to reduce breast tenderness in dosages up to 3000mg per day.
St John’s Wort is a plant serotonin enhancer, which may reduce mood symptoms.
Other preparations such as Chaste Tree have also been used.
Talk to your doctor, naturopath or pharmacist about this group of medicines.
Hormonal Therapies
The combined oral contraceptive pill (COCP) may be prescribed because it prevents ovulation and for some women this will provide relief from her symptoms. The monophasic pill (with the same hormone dose in each active pill) is more beneficial than other types such as either the triphasic or biphasic pills.
Other hormone preparations have been tried such as progestins, progesterone and oestrogen preparations. Only oestrogen patches and implants have shown to be beneficial in controlled studies.
Selective Serotonin Reuptake Inhibitors (SSRI’s)
The SSRI’s have been studied extensively in placebo-controlled trials and have shown significant benefit in reducing symptoms, particularly the emotional symptoms. These medications increase serotonin in the brain and improve mood in particular. The medication may be taken cyclically (in the premenstrual week) or continuously. The most common SSRI is fluoxetine (one form is Prozac), but others also prescribed are sertraline (Zoloft) and paroxetine (Aropax). Many women take this therapy long term without adverse effects.
The SSRI’s are the recommended treatment of choice.
Most women with PMS will respond to either the hormonal therapies or the SSRI’s but there is a small group of women who do not benefit. This group is most likely to have a disorder of mood rather than PMS and should seek specialist help.
PMS is a distressing problem for a small number of women who have severe symptoms.
Conclusion
Unfortunately the cause(s) of PMS are largely unknown but there is more evidence to suggest there are changes in brain chemistry which trigger the symptoms experienced.
There is no "Quick Fix" or cure but there are many ways to help reduce the symptoms and improve quality of life.
Some women benefit from simply charting their symptoms and developing strategies to minimise stress, whereas others may reduce stress with an improved diet and exercise routine.
Other women will require prescriptive medicines such as hormonal therapies or the SSRI’s.
Source: www.jeanhailes.org.au or ring toll free number 1800 151 441
